Shifting Trends and Persistent Disparities in Mortality Related to Liver Cirrhosis and Respiratory Disease: A Population-Based Study in the United States, 1999-2023

Background Liver cirrhosis and respiratory diseases represent major global health burdens, and their coexistence significantly contributes to patient morbidity and mortality. While the epidemiology of each disease has been examined individually, a critical gap persists in our understanding of the long-term mortality trends and disparities associated with their combined impact. Methods We conducted a retrospective, population-based study using the CDC WONDER Multiple Cause of Death database to analyze mortality involving both conditions in the United States from 1999 to 2023. We calculated age-adjusted mortality rates (AAMR) and employed Joinpoint regression to identify annual percentage changes (APC) and average annual percentage changes (AAPC) across diverse demographic and geographic subgroups. Results From 1999 to 2023, a total of 6,957,062 deaths were identified related to liver cirrhosis and respiratory diseases. The overall AAMR was 141.31 in 1999 and 111.04 in 2023, with a significant overall declining trend observed over the study period. Males consistently exhibited higher AAMRs than females (Males: 128.31 vs. Females: 97.26 in 2023). When stratified by race, the highest AAMR was observed in Non-Hispanic White populations, followed by Non-Hispanic Black, Hispanic, and Non-Hispanic Other populations (AAMR of 121.91, 99.07, 93.18, and 56.72, respectively, in 2023). Regionally, the highest mortality was observed in the South, followed by the Midwest, the West, and lastly, the Northeast (with values of 125.75, 120.91, 86.19, and 96.48, respectively, in 2023). Nonmetropolitan areas (150.97) exhibited consistently higher AAMRs than metropolitan areas (110.73) in 2023. Conclusion Liver cirrhosis and respiratory disease-related mortality declined in the United States from 1999 to 2023, with males, Non-Hispanic White populations, and the South exhibiting the highest AAMRs. These findings highlight the importance of improving management and addressing mortality disparities.